Colorado NPI Law

HB 18-1282 requires newly enrolling and currently enrolled organization health care providers (not individuals) to obtain and use a unique National Provider Identifier (NPI) for each service location and provider type enrolled in the Colorado interChange.

The Department of Health Care Policy & Financing (the Department) is responsible for implementing Section 3 of HB 18-1282, which added 25.5-4-419 to the Colorado Revised Statutes. The Department’s regulations are not related to Section 2 of HB 18-1282, and can only answer questions related to our regulations implementing Section 3 of HB 18-1282.

Providers who bill Medicare need to ensure each National Provider Identifier (NPI) for Health First Colorado is also enrolled with Medicare.

  • If a provider needs to add a new NPI to an existing Medicare enrollment, visit the Medicare Enrollment Application web page. The CMS-855 applications specific to organizations are the 855A and 855B forms. Section 4 of each of these applications is where a provider can add an NPI.
  • "How long does the process takes once the application is submitted?" Applications are processed first in/first out, and most applications are processed in 45-60 days.
  • "What effective date would be assigned to a new NPI added in PECOS?" Since the NPI is being added to an existing enrollment, there would be no change in the provider’s Medicare effective date.
  • "Will a new Medicare ID be assigned with the new NPI?" The Medicare ID would stay the same.

For billing guidance, letters, newsletters, and more, please visit the Provider News web page. For information on Revalidation, please visit the Revalidation web page. For information on adding a new NPI, please view the "Provider Maintenance - Adding an NPI" quick guide available on the Quick Guides and Webinars web page.

Contact the Provider Services Call Center at 1-844-235-2387 with questions regarding the Colorado NPI Law.

 
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